SCIENTIFIC
The Impact of COVID-19 Infection on Concurrent Traumatic Insults : An Analysis from the West Virginia Trauma System
AUTHORS : Santiago Lopez , BS 1
Cristhian Perez Torrico , BS 1 Connie DeLa ’ O , MD 2
1
West Virginia University School of Medicine
2
Department of Surgery , West Virginia University School of Medicine
INTRODUCTION
On January 21 , 2020 , the Centers for Disease Control and Prevention reported the first case of SARS-COV-2 ( COVID-19 ) in the United States ( US ) in the state of Washington . 1 West Virginia ( WV ) had the lowest number of cases across America throughout the early days of the pandemic . With the first wave of infections coming in September of 2020 , WV had time to plan and follow treatment protocols developing across the world . 2 Even with this late onset of cases , overall mortality rates at West Virginia University ( WVU ) affiliated hospitals were similar to the nationwide average . 1 Trends throughout the pandemic have shown trauma admissions decreased during the beginning of the pandemic with an increase in penetration wounds . 3-4
ABSTRACT
INTRODUCTION With the onset of the COVID-19 pandemic , elective surgeries were decreased and associated with worsened outcomes . Trauma outcomes have been varied , and rural traumas have not been solely analyzed . This study investigated outcomes related to COVID-19 infection at a rural Level I trauma center in West Virginia ( WV ).
METHODS A retrospective analysis of trauma outcomes of patients aged 18 years and older from March 30 , 2020 , until December 21 , 2021 , presenting to a Level I trauma center in WV was conducted . Data was collected from the John Michael Moore Trauma Center trauma registry . Mortality , complications , injury characteristics , comorbidities , and demographics were examined .
A traumatic insult initiates a cascade of innate immunity reactions due to cellular damage . This cellular damage releases a massive amount of intracellular components known as danger-associated molecular patterns ( DAMPs ). 4-5 These DAMPs directly activate neutrophils , monocytes , and complement pathways , leading to release of interleukins allowing for the possibility of systemic inflammatory response syndrome ( SIRS ) to be induced . 5-7 If sustained , SIRS becomes persistent inflammation , immunosuppression , and catabolism syndrome ( PICS ) and ultimately multi-organ dysfunction syndrome ( MODS ). This inflammatory response is untargeted , which decreases efficiency against pathogens and leads to an increased chance of sepsis . Coagulation also plays a role during a traumatic injury as platelets are activated by proinflammatory mediators that excites the immune system , increasing platelet activity and possibly allowing for a damaging cycle to occur . 8-9
The COVID-19 pandemic brought on a new challenge for proceduralists . The illness itself can be divided into three phases : The first is a viral colonization within the respiratory tract ; the second phase is the migration into the lower respiratory tract , particularly the lung parenchyma , with a non-hypoxic stage ( phase IIA ) leading into a hypoxic stage ( phase IIB ); and finally , the third is the hyperinflammatory phase . 10 This final phase , hypothetically , is the most problematic for patients presenting with traumatic insults , as there are two synergistic inflammatory processes occurring throughout the body , further increasing the systemic inflammatory response that is present with a concurrent traumatic insult . 11 A retrospective cohort study from the University of Pennsylvania
RESULTS Out of 2,118 patients tested for the novel coronavirus , 61 ( 1.7 %) were positive ( COV +). There was no significant increase in mortality regarding COVID-19 infection . COV + patients had an increased length of stay ( median 5.2 vs . 3.6 , p = 0.015 ) and intubation rates ( 21.3 % vs . 12.5 %, p = 0.070 ), but fewer days on a ventilator ( median , 2 vs . 3 , p = 0.012 ). COV + patients were more likely to be discharged to rehabilitation centers , skilled nursing facilities , or long-term acute care hospitals ( 44.3 % vs . 34.5 %), and less often routine or home measures ( 42.6 % vs . 58.7 %) ( p = 0.015 ).
CONCLUSION This single retrospective study found increased rates of length of stay and intubation rates with no increased rates of mortality or complications in COV + trauma patients compared to non-COV + trauma patients . Further research is needed to validate and characterize the impact of COVID-19 for the entirety of the state .
investigated the effects of COVID-19 in the trauma settings during the first wave of the pandemic . Out of 8,170 patients who were tested , 219 tested positive from March 21 , 2020 , until July 31 , 2020 . 12 Analysis of their cohort revealed patients who tested positive had an increased risk of death , post-operative complications , and pulmonary complications compared to those who tested negative . As one of the only studies focusing on trauma patients , further research is needed to analyze the effect of the entire pandemic rather than just the early presentation .
This study aimed to further investigate the effect of COVID-19 on outcomes after trauma . Our hypothesis was that trauma patients with concurrent COVID-19 infection on admission would have higher rates of morbidity and mortality compared to those without infection .
METHODS This retrospective analysis was conducted
30 • www . wvsma . org